ENDOMETRIAL PATTERNS IN ABNORMAL UTERINE BLEEDING –A STUDY OF 300 CASES IN A TERTIARY CARE HOSPITAL IN SOUTH INDIA

Dr. Tejashwini Reddy Punuru 1 , Dr. Vimal Chander R 2 and Prof. Dr. Chitra Srinivasan 3 . 1. Resident of Pathology, Department of Pathology, Saveetha Medical College and Hospital, Chennai, TamilNadu, India. 2. Associate Professor, Department of Pathology, Saveetha Medical College and Hospital, Chennai, TamilNadu, India. 3. Professor and Head of the Department, Department of Pathology, Saveetha Medical College and Hospital, Chennai, Tamil Nadu, India. ...................................................................................................................... Manuscript Info Abstract ......................... ........................................................................ Manuscript History


ISSN: 2320-5407
Int. J. Adv. Res. 5 (9), 1367-1371 1368 clinical diagnosis of endometrial pathology.AUB may be the symptom of endometrial carcinoma in 8-50% of cases. (3,4) As AUB is the most common symptom presented in the Gynaecology outpatient department it is necessary to evaluate the nature of disease and to rule out malignancy , so that it aids in better prognosis of the patient. (1) Until the pathology of underlying causes is accurately diagnosed, correct method of treatment are impossible (5) . Endometrial biopsy or curettage could be a safe and effective diagnostic step in evaluation of abnormal uterine bleeding after ruling out medical causes. (6) Objectives:-1.To determine the incidence of abnormal uterine bleeding in various age groups. 2.To evaluate the histopathological patterns of endometrium in patients presenting with AUB.

Materials and Methods:-
This retrospective study included 300 cases with clinical diagnosis of AUB during a period of one year from January 2016 -January 2017 at Saveetha Medical College, Chennai. The endometrial samplings of patients diagnosed with Abnormal uterine bleeding were formalin fixed and routinely processed. Patient with isolated endometrial causes of AUB were included in the study. The tissues which were ill fixed and inadequate samples were excluded from the study. The paraffin blocks were sectioned at 4-5 µ. The sections were then stained by haemotoxylin and eosin (H&E). Microscopic examination was done by two pathologists, individually to reduce observer bias. The patients were divided into three age groups viz, Group I (reproductive age group):18-40 years, Group II(perimenopausal age group): 41-45 years, and Group III (postmenopausal):>45years.The histopathological changes of endometrium were classified as AUB due to non-organic causes and AUB due to organic causes.
The non-organic causes of AUB included : 1.Secretory phase endometrium 2.Proliferative phase endometrium 3.Atrophic endometrium 4.Disordered proliferative phase endometrium The organic causes of AUB included : 1.Endometrial hyperplasia 2.Endometrial Polyp 3.Complications of pregnancy 4.Endometrial carcinoma The data was collected and analyzed. Analysis was done using Statistical Package for the Social Sciences(SPSS ) software and the data is represented as tables and figures where necessary.

Results:-
In the study a total of 300 samples presenting with abnormal uterine bleeding were obtained of which 7 samples were unsatisfactory. Two hundred and twenty three cases (74.3%) cases revealed no organic pathology while seventy cases (23.3%) showed a definite pathology of the endometrium. The unsatisfactory samples were 7 (2.3%)( Table 1). The age of the patients ranged from 18 -70 years and the maximum no. of cases observed were in the reproductive age group (18-40).
Organic Causes: Among the 70 organic causes of endometrium, different lesions found were due to complications of pregnancy in 44 cases(14.7%) ,endometrial polyp in 6 cases(2%), endometrial hyperplasia in 15 cases(5%), endometrial carcinoma in 5 cases(1.7%).The most common organic lesion in the age group 18-40 years was pregnancy related, in 40-45 year age group was due to endometrial hyperplasia and in the age group above 45 years it was due to carcinoma. (Table 3).

Discussion:-
Abnormal uterine bleeding without structural pathology occurs in reproductive women of all ages but is more common in adolescent and perimenopausal women. (7) The present study comprised of 300 cases of endometrial biopsies of woman of 18-70 years age received in our department. In the present study, the maximum incidence of AUB was in the age group 18-40 yrs age range. The incidence of AUB in >45 yrs of age was lower as compared to those between 18-45 yrs. In our study most of the cases (223) 74.3% were of non organic causes and (70) 23.3% cases were of organic origin.
Among the non organic causes of endometrial pattern in perimenopausal women , most common pattern was the proliferative endometrium (36.08). The cause of bleeding in the proliferative phase could be due to anovulatory cycle. These findings are similar to Vijay Kumar Bodal et al (8) and Sadia Hameed et al. (1) (Table 4) Atrophic Endometrium is the second most common findings in postmenopausal women. The cause of bleeding in atrophic endometrium could be because of vascular variations anatomically or due to abnormal haemostatic mechanisms.
Secretory phase endometrium was found in 24% cases, which is similar as that reported by others (38.4%, 35.4%) (1,9) . (Table 4) We got 6.6% cases with disordered proliferative endometrium. This pattern is at one end of the spectrum of proliferative lesions of the endometrium which includes carcinoma at the other end with intervening stages of hyperplasia. The term "Disordered proliferative endometrium has been used in a number of ways and is somewhat difficult to define (4) It denotes an endometrial appearance that is hyperplasic but without an increase in endometrial volume (4) .Disordered proliferative patterns resembles a simple hyperplasia, but the process is focal rather than diffuse.
Among the organic causes the most common cause of bleeding was due to pregnancy related (14.7%).The second most common cause was endometrial hyperplasia(5%) encountered. Endometrial hyperplasia was observed in 5% of cases. K.Sajtha et al (2) found it to be 25% which is higher than that of our findings( 1370 The incidence of endometrial polyps in our study is 2%. An incidence of (5.12% ,13.8%,11.2% ) were reported in other studies (2,5,6) which is contrast to our study. (Table 4) Endometrial carcinoma was reported in 1.7% of cases which is similar to the other author 2% and 3.3% respectively. (1,3) . This incidence was slightly higher than the results of Muzzaffar et al(0.4%) (9) (Table 4).In our study one of the organic cause of AUB i.e. endometrial carcinoma was seen to be increasing with increase in age.